Assessing the impact of the Royal Canadian Mounted Police (RCMP) protocol and Emotional Resilience Skills Training (ERST) among diverse public safety personnel

Background Public safety personnel (PSP; e.g., border services personnel, correctional workers, firefighters, paramedics, police, public safety communicators) are frequently exposed to potentially psychologically traumatic events. Such events contribute to substantial and growing challenges from posttraumatic stress injuries (PTSIs), including but not limited to posttraumatic stress disorder. Methods The current protocol paper describes the PSP PTSI Study (i.e., design, measures, materials, hypotheses, planned analyses, expected implications, and limitations), which was originally designed to evaluate an evidence-informed, proactive system of mental health assessment and training among Royal Canadian Mounted Police for delivery among diverse PSP (i.e., firefighters, municipal police, paramedics, public safety communicators). Specifically, the PSP PTSI Study will: (1) adapt, implement, and assess the impact of a system for ongoing (i.e., annual, monthly, daily) evidence-based assessments; (2) evaluate associations between demographic variables and PTSI; (3) longitudinally assess individual differences associated with PTSI; and, (4) assess the impact of providing diverse PSP with a tailored version of the Emotional Resilience Skills Training originally developed for the Royal Canadian Mounted Police in mitigating PTSIs based on the Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders. Participants are assessed pre- and post-training, and then at a follow-up 1-year after training. The assessments include clinical interviews, self-report surveys including brief daily and monthly assessments, and daily biometric data. The current protocol paper also describes participant recruitment and developments to date. Discussion The PSP PTSI Study is an opportunity to implement, test, and improve a set of evidence-based tools and training as part of an evidence-informed solution to protect PSP mental health. The current protocol paper provides details to inform and support translation of the PSP PTSI Study results as well as informing and supporting replication efforts by other researchers. Trial registration Hypotheses Registration: aspredicted.org, #90136. Registered 7 March 2022—Prospectively registered. Trial registration: ClinicalTrials.gov, NCT05530642. Registered 1 September 2022—Retrospectively registered. The subsequent PSP PTSI Study results are expected to benefit the mental health of all participants and, ultimately, all PSP. Supplementary Information The online version contains supplementary material available at 10.1186/s40359-022-00989-0.


T1 DA1
First Daily Assessment -Group 1 (i.e., "DA1") T1 FA1 First Full Survey -Group 1 (i.e., "F1") Week 2 T1 FA1 First Clinical Interview -Group 1 (i.e., "C1") T1 N Participants from separate sectors (i.e., fire, police, paramedics, public safety communicators) were brought into the study in a staggered approach. Fire was onboarded in November 2021; police were onboarded in January 2022; paramedics were onboarded in February 2022; and public safety communicators were onboarded end of April 2022. b Participants within each sector were on-boarded and interviewed in two separate groups to accommodate shift work and clinician workload. c ERST Training sessions were offered twice weekly and occasionally more than 1 week apart due to shift work concerns. Trainers adhered to the above schedule as closely as possible, while accommodating shift work and the specific logistics needs of each sector community.
Supplemental Table 2

Supplemental Psychometrics and References for Self-Report Measures (Alphabetically)
Alcohol Use Disorders Identification Test (AUDIT; (1)). The AUDIT is a 10-item self-report questionnaire comprised of items assessing alcohol intake, alcohol dependence, and adverse consequences of alcohol use over the past 12 months. Items such as "How many drinks containing alcohol do you have on a typical day?" are reported on a 5-point Likert-type scale ranging from 0 (never) to 4 (daily or almost daily). A positive screen for AUD was determined based on total score (i.e., scores greater than 15 can be used to identify clinically significant hazardous drinking and dependence; (2)). Psychometric evaluation of the AUDIT has demonstrated good internal consistency (α = .85) and good test-retest reliability (r = .83 to .95) in the general population (3,4) and in police populations (α = .81; (5)).
Anxiety Sensitivity Index-3 (ASI-3; (6)). The ASI-3 is an 18-item self-report measure assessing the tendency to fear anxiety symptoms based on the belief that they may have harmful consequences. Items such as "When my chest feels tight, I get scared that I won't be able to breathe properly," are rated on a 0 (agree very little) to 4 (agree very much) Likert scale. Higher scores indicate greater sensitivity to anxiety symptoms. Factor analysis supports a three-factor structure (i.e., somatic, cognitive, and social fears), which correspond to the three theorized dimensions of anxiety sensitivity (i.e., fear of somatic sensations, fear of cognitive dyscontrol, and fear of socially observable signs of anxiety, respectively). The ASI-3 has been found to have better factorial validity and internal consistency relative to the original Anxiety Sensitivity Index (7) and has displayed convergent, discriminant, and criterion validity (6). Psychometric evaluation of the ASI-3 has indicated good internal consistency (αs = .83, .86, and .79 for somatic, cognitive, and social fears subscales respectively, as well as α = .89 for the ASI-3 total score) and good test-retest reliability (rs = .45, .51, and .39 for somatic, cognitive, and social fears respectively, as well as r = .31 for the ASI-3 total score; (8)).
Beliefs about Emotions Scale (BES; (9)). The BES is a 12-item self-report scale designed to measure respondents' beliefs about the unacceptability of experiencing and expressing emotions. Each item is measured on a seven-point Likert scale, ranging from 0 (totally disagree) to 6 (totally agree). Higher scores indicate greater beliefs that it is unacceptable for respondents to experience or express emotion. The scale has high internal consistency (α = .91). Measures of dysfunctional attitudes, self-sacrifice, and problematic perfectionism, as well as symptoms of depression, anxiety, and fatigue, have also been significantly correlated with scores on the BES.
Brief Experiential Avoidance Questionnaire (BEAQ; (10)). The BEAQ is a 15-item self-report scale created to provide a shortened alternative to the Multidimensional Experiential Avoidance Questionnaire (MEAQ; (11)). The BEAQ assesses a broad range of experiential avoidance dimensions such as avoidance, psychopathology, and quality of life. Items such as "I'm quick to leave any situation that makes me feel uneasy," are rated on a 6-point Likert scale ranging from 1 (strongly disagree) to 6 (strongly agree). Higher scores indicate greater avoidance. Psychometrics evaluation of the BEAQ has demonstrated good internal consistency (α = .84) in veterans seeking outpatient treatment and adequate consistency (α = .77) in veterans seeking residential treatment for PTSD (12).
Brief Fear of Negative Evaluation Scale -Straightforward Items (BFNE-S; (13)). The BFNE-S is comprised of the eight straightforwardly worded items from the original BFNE (14) and assesses fears of negative evaluation with 5-point Likert scales from 0 (not at all characteristic of me) to 4 (extremely characteristic of me). Higher scores indicate greater fear of negative evaluation. Use of only the straightforward items has been ratified by recent comparative analyses (15). The BFNE-S has demonstrated excellent internal consistency, factorial validity, and construct validity in undergraduate (αs = .94 to .96; (16,17)) and clinical (αs = .90 to .96; (13)) samples.
Brief Resilience Scale (BRS; (18)). The BRS is a 6-item self-report measure designed to assess resilience, or a person's ability to bounce back or recover from stress. Items such as "I tend to bounce back quickly after hard times," are rated on a scale from 1 (strongly disagree) to 5 (strongly agree).
Higher scores indicate a greater sense of resiliency. The BRS has demonstrated good test-retest reliability and internal consistency (αs = .80 to .91) across clinical and non-clinical samples, and has been independently determined to be among the most psychometrically sound of available resilience measures (19).
Canadian Armed Forces Recruit -Mental Health Service Use Questionnaire (CAFR-MHSUQ; (20)). The CAF-R-MHSUQ is a 4-item self-report questionnaire designed to measure a participant's willingness to seek mental health services. Items such as "If I developed mental health problems, I would expect to seek mental health treatment from a professional," are rated on a 5-point Likert scale ranging from 1 (strongly agree) to 7 (strongly disagree). Higher scores indicate greater willingness to seek mental health services.
Cannabis Use Disorders Identification Test -Revised (CUDIT-R; (21,22)). The CUDIT-R is an 8item self-report questionnaire designed to measure cannabis use and misuse. Items such as "How often do you use cannabis?" are rated on a 5-point Likert scale ranging from 0 to 4, with anchors changing based on the item. A positive screen for CUD is determined based on total score (i.e., a cut-off score of 13 or higher indicating clinically significant hazardous use and dependence). The CUDIT-R is well supported, with high sensitivity (i.e., 91%) and specificity (i.e., 90%) for identifying problematic use (21,22). Psychometric evaluation of the CUDIT-R has demonstrated good internal consistency among college students (α = .83; (23)).

Childhood Stressors Screen (CSS)
. The CSS is a 22-item self-report questionnaire designed to measure aversive childhood experiences. Items such as "When you were growing up, how often did your family run out of money or find it hard to pay for basic necessities life food or clothing?" are rated a Likert-style scale ranging from 0 (never) to 4 (very often). Most CSS items were derived from the Canadian Community Health Survey: Mental Health, 2012 (24). Items three, four, and five were derived from the Childhood Experiences of Violence Questionnaire (25). A shortened version was introduced at F1 for fire and for all police, paramedic, and public safety communicators milestone assessments based on a subset of items suggested by Afifi (personal communication, November 15, 2021). Items 1, 2, 5, and 14 to 22 were retained from the original version.
Chronic Pain Questionnaire (CPQ; (26)). The CPQ is a self-report questionnaire designed to measure the location, intensity, and duration of physical chronic pain. Items such as "Do you experience chronic pain?" are answered with face-valid options (e.g., yes, no). Additionally, items such as "What caused the chronic pain that most interfered with your life?" are rated on a Likert-like scale (e.g., Injury related to active duty, Injury related to work other than active duty). The CPQ is a new measure and psychometrics will be available as soon as possible.
Depression Anxiety Stress Scale -21 (DASS; (27,28)). The DASS is a 21-item self-report questionnaire designed to measure the negative emotional states of depression, anxiety, and stress. Given that symptoms of MDD and GAD were measured with other questionnaires (i.e., PHQ-9 and GAD-7), only the Stress subscale was used. The Stress subscale is sensitive to levels of chronic non-specific arousal and assesses difficulty relaxing, nervous arousal, and being easily upset/agitated, irritable/over-reactive and impatient. Respondents are asked to use 4-point severity/frequency scales ranging from 0 (did not apply to me) to 3 (applied to me very much) to rate the extent to which they have experienced each state over the past week.
Higher scores indicate greater subjective experiences of stress. Psychometric assessment of the Stress subscale has indicated good internal consistency (α = .78; (29)) among medical students and excellent internal consistency (α = .91; (30)) among a community sample. (31)). The DAR-5 is a 5-item questionnaire assessing participants' self-reported levels of anger. Items such as "When I got angry at someone, I wanted to hit them," are rated on a 1 (none or almost none of the time) to 5 (all or almost all of the time) Likert scale.

Dimensions of Anger Reactions -5 (DAR-5;
Higher scores indicate greater self-reported levels of anger. The DAR-5 was adapted from the original Dimensions of Anger Reactions measure (32), which displayed strong psychometric properties but was lengthy and overcomplicated. The resulting DAR-5 has displayed concurrent validity with the commonlyused State Trait Anger Expression Inventory 2 (33) and predictive of changes in PTSD; further, it displays strong internal reliability (α = .90), a robust one-factor structure, and is recommended for screening anger in long questionnaire batteries (34).
Discrimination Questions. Institutional discrimination and harassment were evaluated using 4-items: 1) "Have you experienced sexual harassment in relation to your work (for example, in a work setting, from a colleague but outside of work, etc.)?"; 2) "Have you experienced sexual assault in relation to your work (for example, in a work setting, from a colleague but outside of work, etc.)?"; 3) "Have you experienced harassment (non-sexual) in relation to your work (for example, in a work setting, from a colleague but outside of work, etc.)?"; and 4) "Have you experienced discrimination in relation to your work (for example, in a work setting, from a colleague but outside of work, etc.)?". The items included face-valid response options (i.e., yes, no, prefer not to answer). Participants were also asked to identify the grounds on which they were discriminated against (e.g., race, sex, gender identity). The items were adapted from previous work done by the International Women's Media Foundation (https://www.iwmf.org/wpcontent/uploads/2018/06/Violence-and-Harassment-against-Women-in-the-News-Media.pdf).
Drinking Motives Questionnaire -Short Form (DMQ-SF; (35)). The DMQ-SF is a 4-item self-report questionnaire that assesses motives for drinking behaviours. Items such as "How often do you use alcohol to manage physical pain?" are rated on a 5-point Likert scale ranging from 0 (never) to 4 (daily or almost daily). The DMQ was designed for large-scale screenings as part of demographic history and is entirely dependent on participant self-report.
Dyadic Adjustment Scale -4 (DAS-4; (36)). The DAS-4 is a 4-item self-report questionnaire that assesses marital satisfaction. Items such as "In general, how often do you think that things between you and your partner are going well?" are rated on a 1 (never) to 6 (all the time) Likert scale. Higher scores indicate greater subjective marital satisfaction. The DAS-4 has displayed very good psychometric properties (36).
Emotion Regulation Questionnaire (ERQ; (37)). The ERQ is a 10-item questionnaire designed to assess how an individual regulates positive and negative emotions. The ERQ has two subscales: 1) Cognitive Reappraisal, which evaluates a participants ability to change their thinking (e.g., "When I want to feel more positive emotion (such as joy or amusement), I change what I'm thinking about."); and 2) Emotion Suppression, which evaluates the extent to which participants repress their emotions (e.g., "When I'm feeling negative emotions I make sure not to express them."). Items are rated on a 1 (strongly disagree) to 7 (strongly agree) Likert scale. The ERQ has displayed good internal reliability (αs range from .73 to .79) and test-retest reliability across three months (37), as well as a robust factor structure (37).

Expression of Moral Injury Scale -Military -Short Form
(EMIS-M-SF; (38)). The EMIS-M-SF is a 4-item self-report measure designed to swiftly assess for warning signs of a moral injury in military populations. Items (e.g., "I feel guilt about things that happened during my military service that cannot be excused.") are rated on a 1 (strongly disagree) to 5 (strongly agree) Likert scale. Higher scores indicate greater experience of moral injury. The EMIS-M-SF has been psychometrically validated in a military sample, with good internal consistency (α = .84).
Generalized Anxiety Disorder Scale -7 (GAD-7; (39)). The GAD-7 is a 7-item self-report measure assessing for symptoms of anxiety and worry. Participants are asked to rate their experiences of symptoms over the last two weeks (e.g., "Feeling nervous, anxious, or on edge") on a 0 (not at all) to 3 (nearly every day) Likert scale. A positive screen for generalized anxiety disorder (GAD) was determined based on total score (i.e., scores greater than 9 can be used to identify persons reporting clinically significant symptoms; (40)). The GAD-7 has good reliability, and construct, criterion, procedural, and factorial validity (39), as well as good internal consistency (α=.89) and inter-item correlations (.45-.65) in a community sample (41).
HEXACO Personality Inventory -100-item scale (HEXACO-100; (42)). The HEXACO-100 is a selfreport measure which corresponds to the six personality dimensions identified in the HEXACO model (43). Items such as "People sometimes tell me that I am too critical of others," are ranked on a 1 (strongly disagree) to 5 (strongly agree) Likert scale. The HEXACO model of personality is comprised of six personality dimensions: honesty/humility, emotionality, extraversion, agreeableness, conscientiousness, and openness (44). The HEXACO-100 is psychometrically sound, with good internal consistency in college and community samples (αs range from .81 to .85), inter-factor correlations ranging from |.02| to |.42|, and convergent validity with other measures of personality (42). Based on participant and clinician feedback, a shortened form of the HEXACO-100 (HEXACO-60; (45)) was introduced after F1 for fire and for all police, paramedic, and public safety communicators milestone assessments.
HEXACO Personality Inventory -60-item scale (HEXACO-60; (45)). The HEXACO-60 is a short version of the 100-item HEXACO personality inventory, with 10 items from each of the 6 personality dimensions in the HEXACO model (43). Items (e.g., "I often push myself very hard when trying to achieve a goal.") are rated on a 1 (strongly disagree) to 5 (strongly agree) Likert scale. The HEXACO-60 has been psychometrically validated with acceptable internal consistency in both an undergraduate (αs range from .77 to .80) and a community sample (αs range from .73 to .80). In addition to the standard HEXACO-60 items, items 97 to 100 of the HEXACO-100 were retained, as these constitute an interstitial facet absent from the standard 60-item version. The HEXACO-60 plus these four interstitial facet items replaced the HEXACO-100 after F1 for fire and for all police, paramedic, and public safety communicators milestone assessments.
Illness/Injury Sensitivity Index -Revised (ISI-R). The ISI-R is 9-item revision of the original Illness/Injury Sensitivity Index (46) designed to measure fears of illness and injury (e.g., "I worry about my physical health."). Items are rated on a 5-point Likert scale ranging from 0 (agree very little) to 4 (agree very much). Two factors, Fear of Illness (e.g., "I worry about becoming physically ill.") and Fear of Injury (e.g., "I am frightened of being injured."), are represented within the ISI-R (47); however, the total summed score is used in most analyses, with higher scores indicating greater fear. The ISI-R has excellent internal consistency (α = .86), convergent validity with other measures related to injury and illness (r > .65), and correlates highly with the original index, r = .96 (48). (ISI; (49)). The ISI is a 7-item self-report questionnaire that assesses difficulties with falling or staying asleep. Items such as "How satisfied/dissatisfied are you with your current sleep pattern?" are rated on a 5-point Likert scale ranging from 0 (very satisfied) to 4 (very dissatisfied). Higher scores indicate greater sleep difficulties. The ISI has solid psychometric support including adequate internal consistency (i.e., α = .74 to .78), sensitivity (94%), specificity (94%), and convergent validity (50).

Insomnia Severity Index
Institutional Betrayal and Support Questionnaire (IBSQ; (51)(52)(53)). The IBSQ is a 29-item self-report questionnaire that assesses for feelings of support versus lack of support by an institution. The questionnaire was modified to measure perceptions of support received by the PSP following exposures to diverse potentially psychologically traumatic events (PPTEs). PSP are asked whether their organization played a role following exposure by responding in any of several different ways, such as "Meeting your needs for support and accommodations," and "Responding inadequately to the experience/s, if reported." Response options include yes, no, and N/A. Preliminary research with an earlier version of this measure has revealed a one-factor solution. The questionnaire has been modified to ask specifically about experiences with the institution participants are employed by at the time of research (51,52). Based on participant and clinician feedback, a short form of the ISBQ (IBQ2; (54)) was introduced after F1 for fire and for all police, paramedic, and public safety communicators milestone assessments.
Institutional Betrayal Questionnaire -2 (IBQ2; (55)). The IBQ2 is a 12-item self-report questionnaire that measures feelings of betrayal towards an institution after experiencing a potentially psychologically traumatic event (e.g., sexual assault, motor vehicle accident, sudden death). Respondents are asked to consider larger institutions (e.g., church, military unit, workplace) to which they belong or have belonged and consider whether or not the institution played a role in a previously identified event. Items include various actions an organization could take such as "Not taking proactive steps to prevent this type of experience," and "Denying your experience in some way." Response options include yes, no, and N/A. The IBQ2 has been validated in a sample of sexual assault survivors and showed good convergent and discriminant validity (55). The IBQ2 replaced the ISBQ after F1 for fire and for all police, paramedic, and public safety communicators milestone assessments. (56)). The IUS-12 is a 12-item questionnaire that measures responses to uncertainty, ambiguous situations, and the future. Items are rated on a 5-point Likert scale ranging from 1 (not at all characteristic of me) to 5 (entirely characteristic of me). Higher scores indicate greater intolerance of uncertainty. The IUS-12 has a continuous latent structure and has two factors (56, 57), prospective IU (7 items; e.g., "I can't stand being taken by surprise.") and inhibitory IU (5 items; e.g., "When it's time to act, uncertainty paralyses me."). The IUS-12 has sound psychometric properties (56,58) and strong internal consistency for the total and subscale scores (αs range from .85 to .91; (56)).

Intolerance of Uncertainty Scale -Short Form (IUS-12;
Life Event Checklist for DSM-5 (LEC-5; (59, 60)). The LEC-5 is a commonly used tool for assessing self-reported exposures to diverse PPTE. The LEC-5 presents respondents with 17 different PPTE types each with six response options including happened to me, witnessed it, learned about it, part of my job, not sure, or doesn't apply (60). LEC for DSM-IV has demonstrated good convergent and discriminant validity, test-retest reliability over a 7-day period, and concurrent validity with other measures of PPTE exposures (59,61). The only difference between LEC-5 and the LEC for DSM-IV is that the LEC-5 allows respondents to report PPTE exposures that occurred "as part of my job," which corresponds with contemporary PTSD diagnostic criteria (62). In the current study, participants were asked specifically about PPTE exposures that occurred "as part of my public safety job," to avoid confounds with other employment. For the First Full Survey participants were asked to report on PPTE during their "entire life (growing up, as well as adulthood)"; in contrast, for subsequent surveys, participants were asked to report on PPTE "since you last completed this questionnaire." McGill Pain Questionnaire -Short Form (MPQ-SF; (63)). The MPQ-SF is a commonly used tool for the measurement of pain experience. The MPQ-SF includes a pain rating index (PRI) of 15 of the most commonly used adjectives that describe sensory and affective aspects of pain (64). The MPQ-SF also includes a visual analogue scale (VAS) to help assess pain intensity. The checklist is rated on a 4-point intensity scale ranging from 0 (none) to 3 (severe). The MPQ-SF has been found to correlate highly with the original MPQ (64), and demonstrates good factorial validity for both sensory and affective components (.78 and .76 respectively; (64)). Based on participant and clinician feedback, the RPI and PPI were removed after F1 for fire and from all police, paramedic, and public safety communicators milestone assessments, retaining only the VAS.

Medications and Drug Use Scale (MDUS; Carleton, Duranceau, & LeBouthillier, 2016
; unpublished scale). The MDUS is a 5-item self-report questionnaire that assesses self-reported use of medications and drugs not otherwise assessed by demographics. Items such as "Do you regularly use any prescription or over-the-counter medications?" are responded to with face-valid options (e.g., yes, no). The MDUS was designed for large-scale screenings as part of demographic history and is entirely dependent on participant self-report.
Mental Health Continuum -Short Form (MHC-SF; (65)(66)(67)). The MHC-SF is a 14-item scale designed to measure emotional, psychological, and social well-being. The MHC-SF was derived as a shortened version of the Mental Health Continuum Long Form and has good internal reliability (α = .74; (65)). The MCH-SF measures the degree of 1) emotional well-being, 2) psychological well-being, and 3) social well-being (65). Items are rated on a 6-point Likert scale ranging from 0 (never) to 5 (every day). Higher scores indicate greater perceived well-being in each of the three areas. The MHC-SF has also demonstrated good internal reliability in French (αs for subscales range from .78 to .90; (67)) and in Dutch (α = .89 and αs for subscales range from .74 to .83; (66)). (MAKS; (68)). The MAKS is a 15-item self-report questionnaire designed to measure mental health literacy and stigma. Items such as "Most people with mental health problems want to have paid employment," are rated on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). Higher scores indicate greater mental health literacy. The MAKS is a relatively new measure, but the available psychometric data support the internal consistency (α = .65) and test-retest reliability (.57 to .87) of the measure (68); in addition, the measure appears sensitive to changes based on interventions (69). Based on participant and clinician feedback, the MAKS was identified as redundant with other measures and was removed after F1 for fire and from all police, paramedic, and public safety communicators milestone assessments. (OMSWA; (70)). The OMSWA is a 22-item selfreport questionnaire designed to measure mental health stigma and workplace attitudes. Items such as "I would be upset if a co-worker with a mental illness always sat next to me at work," are rated on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). Higher scores indicate greater stigmatizing attitudes towards mental health conditions in the workplace. The OMSWA is a relatively new measure, but the available psychometric data support the internal consistency of the measure (70). The measure is currently in use as a standard metric by the Mental Health Commission of Canada. Based on participant and clinician feedback, a short form of the OMSWA was introduced after F1 for fire and for all police, paramedic, and public safety communicators milestone assessments.

Opening Minds Survey of Workplace Attitudes
Opening Minds Survey of Workplace Attitudes -Short Form (OMSWA-SF; (71)). The OMSWA-SF is a 9-item self-report questionnaire designed to briefly assess stigmatizing attitudes in the workplace. Items (e.g., "I would not be close friends with a co-worker who I knew had mental illness.") are rated on a 1 (strongly disagree) to 5 (strongly agree) Likert scale. Higher scores indicate greater stigmatizing attitudes towards mental health conditions in the workplace. The OMSWA-SF has been psychometrically validated in a sample of PSP, with good internal consistency (α = .89). The OMSWA-SF replaced the OMSWA after F1 for fire and for all police, paramedic, and public safety communicators milestone assessments.
Pain Anxiety Symptoms Scale -20 (PASS-20; (72)). The PASS-20 is a short form of the original Pain Anxiety Symptoms Scale (PASS; (73)) used to measure pain-related anxiety. Each of the 20 items (e.g., "When I feel pain I am afraid that something terrible will happen.") are rated on a 6-point Likert scale ranging from 0 (never) to 5 (always). Each of four, 5-item subscales (i.e., Cognitive, e.g., "I can't think straight when in pain;" Fear, e.g., "Pain sensations are terrifying;" Escape/Avoidance, e.g., "I will stop any activity as soon as I sense pain coming on;" and Physiological, e.g., "Pain makes me nauseous.") provides a score that can be considered separately or, when summed, as a general measure of pain-related anxiety. Higher scores indicate greater pain-related anxiety. Factorial validity for both the total and subscale scores has been demonstrated for clinical (α = .83; (74)) and non-clinical samples (α = .91; (75)). (PDSS; (76)). The PDSS is a 7-item self-report measure designed to assess symptoms of panic disorder (e.g., "During the past week, were there any activities that you avoided or felt afraid of because they caused physical sensations like those you feel during panic attacks?"). The items assess panic frequency, distress during panic, panic-focused anticipatory anxiety, phobic avoidance of situations, phobic avoidance of physical sensations, impairment in work functioning, and impairment in social functioning. Items are rated on a 5-point Likert scale ranging from 0 (none) to 4 (extreme). A positive screen for panic disorder was determined based on total score (i.e., scores greater than 7 can be used to identify persons reporting clinically significant anxiety and distress; (77)). The self-report version of the PDSS has displayed excellent psychometrics, with one study finding strong internal validity (α = .92) and a correlation of .81 with the original measure (78).

Panic Disorder Severity Scale
Parental Assessment of Childhood Stress (PACS; Carleton, Duranceau, & Wright, 2016; unpublished scale). The PACS is a 26-item self-report questionnaire that assesses the degree to which a parent serving in public safety believes their child is experiencing distress that may be associated with the realities of such service. The PACS is a new measure and psychometrics will be available as soon as possible.
Posttraumatic Growth Inventory -Short Form (PTGI-SF; (84)). The PTGI-SF is a 10-item self-report questionnaire briefly assessing growth in response to traumatic events. Items (e.g., "I learned a great deal about how wonderful people are.") are rated on a 0 (I did not experience this change as a result of my crisis) to 5 (I experienced this change to a very great degree as a result of my crisis) Likert scale. Higher scores indicate greater posttraumatic growth. The PTGI-SF has been psychometrically validated in a large sample, with good internal consistency (α = .89) and can be reliably used in place of the full version with little loss of information.
PTSD Checklist for DSM-5 (PCL-5; (60)). The PCL-5 is a 20-item self-report measure used to assess symptoms of posttraumatic stress disorder (PTSD) experienced in the past month and to screen for persons reporting clinically-significant symptoms. Participants use a Likert scale ranging from 0 (not at all) to 4 (extremely) to rate how bothered they had been by different PTSD symptoms (e.g., "Repeated, disturbing memories, thoughts, or images of the stressful experience") over the past month. A positive screen for PTSD is determined based on total score (i.e., a score greater than 32 used to identify clinically significant symptoms), as well as meeting criteria on each individual symptom cluster (60). Psychometric evaluation has found the PCL-5 to be a reliable and valid measure of PTSD symptoms as described in the Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (62), with strong internal consistency (α = .94) and test-retest reliability (r = .82) in PPTE-exposed populations (85).
Public Safety Personnel Stressors (PSP-Stress; (86)). The PSP-Stress is a 40-item self-report questionnaire designed to measure environmental stressors specific to public safety officers. The scale was created by combining the 20-item Operational Police Stress Questionnaire (PSQ-Op) and the 20-item Organizational Police Stress Questionnaire (PSQ-Org). Items such as "The feeling that different rules apply to different people (e.g., favouritism)," are rated on a 7-point Likert scale ranging from 1 (no stress at all) to 7 (a lot of stress). Higher scores indicate greater subjective levels of stress. The PSP-Stress is a new measure and psychometrics will be available as soon as possible. The PSQ-Op scale has adequate reliability with a coefficient alpha of .93 and corrected item-total correlations ranging from .50 to .70. The PSQ-Org scale has adequate reliability with a coefficient alpha of .92 and corrected item-total correlations ranging from .41 to .73 (86).
Public Safety Personnel Support (PSP-Support; Carleton, 2015; unpublished scale). The PSP-Support is a 15-item self-report questionnaire designed to measure environmental supports specific to public safety officers. Items such as "Your family" are rated on a 5-point Likert scale ranging from 1 (I feel undermined) to 5 (I feel as supported as I could ever hope to be). Higher scores indicate greater subjective levels of support. The PSP-Support is a new measure and psychometrics will be available as soon as possible. The RSSS is a 14-item self-report questionnaire designed to measure environmental supports specific to Royal Canadian Mounted Police members. Items were adapted to fit all PSP for the current study (e.g., changing RCMP officer to PSP). Items such as "Do you feel that your supervisor would support you if you developed a mental illness/injury?" are rated on a 5-point Likert-type scale ranging from 1 (strongly disagree) to 5 (strongly agree). The RSSS is a new measure and psychometrics will be available as soon as possible.
Self-Care and Mental Health Access for Public Safety (SCMHA-PS; Carleton, Duranceau, & LeBouthillier, 2016; unpublished scale). The SCMHA-PS is a 25-item self-report questionnaire designed to measure environmental supports specific to public safety officers. The questionnaire contains two scales and one open-ended question. Items such as "Spouse" are rated on a 7-point Likert scale ranging from 1 (I can and would access as an early resource) to 7 (I don't know if I have access). The questionnaire contains one item with multiple open-ended sub-questions which asks, "How many days per week do you do each of the following activities?" There are 10 sub-questions with items such as "Socializing with other First Responders or other Public Safety Personnel?" The questionnaire also contains items such as "Contact mental health professionals for well-being (e.g., psychologists, therapists)" which are rated on a 5-point Likert scale ranging from 1 (never) to 5 (annually). The SCMHA-PS is a new measure and psychometrics will be available as soon as possible.
Social Interaction Phobia Scale (SIPS; (87)). The SIPS is a 14-item self-report measure designed to assess symptoms specific to social anxiety disorder (SAD; e.g., "When mixing socially I am uncomfortable."). Each item is measured on a 5-point Likert scale, ranging from 0 (not at all characteristic of me) to 4 (entirely characteristic of me). Higher scores indicate greater symptoms of social anxiety. The items were derived as a subset of items from the Social Interaction Anxiety and Social Phobia Scales (88). The SIPS is designed to measure three symptom dimensions of SAD: social interaction anxiety; fear of overt evaluation; and fear of attracting attention. SIPS total and subscale scores account for equivalent or greater variance relative to the original SIAS and SPS total scores (87). The SIPS total score has demonstrated excellent internal consistency (α = .92) with adequate internal consistency (αs = .76 to .86) exhibited by all three sub-scales among undergraduate students (89). Similar results were found among patients with principal SAD and principal GAD patients, and slightly lower values but still good internal consistency were observed among healthy control sample (90). Use of the total score typically provides sufficient sensitivity and specificity for discerning clinical and nonclinical samples (i.e., scores greater than 20 can be used to identify persons reporting clinically significant distress). Subsequent research has replicated the psychometric properties, as well as convergent and discriminant validity, of the SIPS in a large and independent sample (89). The SIPS is included as a measure of dimensional SAD symptoms (87,91).
Social Provisions Scale -10 (SPS-10; (92,93). The SPS is a 10-item short form of the original measure designed to measure perceived social support (92). Items such as "There are people I can depend on if I really need it," are rated on a 4-point Likert scale ranging from 1 (strongly disagree) to 4 (strongly agree).
Higher scores indicate greater feelings of social support. The SPS-10 has demonstrated excellent internal consistency (α = .88), concurrent validity (r = .93), and factorial validity (92). Based on participant and clinician feedback, the SIPS was identified as redundant with other measures and removed after F1 for fire and from all police, paramedic, and public safety communicators milestone assessments.
Southampton Mindfulness Questionnaire (SMQ; (94)). The SMQ is designed to provide a measure of mindful awareness of distressing thoughts and images. The SMQ is a 16-item scale with items such as, "Usually when I experience distressing thoughts and images, I am able to accept the experience," rated on a 7-point Likert scale ranging from 0 (strongly disagree) to 6 (strongly agree). Higher scores indicate greater ability to manage emotional reactions to distressing thoughts and images. Psychometric properties of the SMQ have exhibited an excellent internal consistency (α = .89) for the total sample and an acceptable consistency for the community (α = .89) and clinical (α = .82) groups; with corrected itemtotal correlations of r = .54 (94).
Tobacco Use Questionnaire (TUQ; (95)). The TUQ is an 8-item self-report questionnaire that assesses self-reported tobacco use. Items such as "Do you use tobacco (e.g., cigarettes, smokeless)?" are responded to with face-valid options (e.g., yes, no). The TUQ was designed for large-scale screenings as part of demographic history and is entirely dependent on participant self-report. Items were derived following review of the World Health Organization's Global Adult Tobacco Survey (95).
Unified Protocol Behavioral Avoidance Questionnaire (UPBAQ; (96)): The UPBAQ is a 5-item measure that was developed explicitly to assess the skill of approach-oriented behavior as it is taught in the Unified Protocol (UP). Participants rated items (e.g., "The way I acted in situations was driven by my distressing emotions," "I tried to avoid distressing emotions by avoiding situations that might cause them.)" by indicating how often they use each skill on a scale from 1 (never) to 5 (always or when needed). Higher scores indicate greater levels of emotional avoidance. The UPBAQ has demonstrated good internal consistency and validity (97).
Unified Protocol Cognitive Questionnaire (UPCQ; (98)). The UPCQ is a 7-item measure that was developed explicitly to assess the skill of cognitive flexibility as it is taught in the Unified Protocol (UP) as existing questionnaires assessing cognitive coping either included skills that are not emphasized in the UP or excluded key concepts covered in this module. Participants rated items (e.g., "I evaluated my thinking when I experienced a distressing emotion," "I understood that my thoughts can have an effect on my feelings and behaviors.") by indicating how often they use each skill on a scale from 1 (never) to 5 (always or when needed). Higher scores indicate greater use of cognitive coping skills. The UPCQ has demonstrated good internal consistency and validity (97). (UPKA; (97)). The UPKA questionnaire consists of 13 true/false items designed to assess core concepts taught during the PSP Emotional Resilience Skills Program. Example items include, "The goal of your emotional resilience course is to learn how to eliminate unwanted emotions like fear, anxiety, and sadness," and "How we currently feel can affect the way we interpret many situations." Several randomized controlled trials have assessed the efficacy of the psychological intervention on which the PSP ERST was based (e.g., (98)).

Unified Protocol Knowledge Acquisition
Utrecht Work Engagement Scale -9 (UWES-9; (99)). The UWES-9 is a 9-item questionnaire assessing a person's work-related state of fulfillment. Questions such as "I am proud of the work that I do," are rated on a 6-point scale from 0 (never) to 6 (always). Higher scores indicate greater levels of work-related fulfillment. The UWES-9 has evidenced adequate internal consistency (αs = .75 to .85) and a more temporally stable factor structure than longer versions of the UWES (100).